Published in:
01-10-2010 | Original Clinical Article
Deformity and functional outcome after treatment for supracondylar humerus fractures in children: a 5- to 10-year follow-up of 139 supracondylar humerus fractures treated by plaster cast, skeletal traction or crossed wire fixation
Published in: Journal of Children's Orthopaedics | Issue 5/2010
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Purpose
At Haukeland University Hospital (HUH), we used overhead skeletal traction for displaced supracondylar humerus fractures (SCHF) in children until closed reduction and crossed wire fixation was introduced in the early 1990s. Though there are obvious and well-documented benefits of wire fixation, the aim of this study was to document and compare the results and complication rates for both methods.
Patients and methods
One hundred and thirty-nine patients treated for SCHF between 1988 and 1998 were available for follow-up. Of these, 40 children were treated with a plaster cast, 46 with overhead skeletal traction and 45 with crossed wire fixation. Eight children were treated with open reduction and crossed wires. The mean time to follow-up was 7.1 years [standard deviation (SD) 3.2].
Results
The length of hospital stay was 2 days for those treated with crossed wire fixation compared to 11 days for traction (P < 0.001). The rate of nerve injury in Gartland type 3 fractures was 19%. There was no significant difference in the number of complications or in the functional outcome after skeletal traction or wire fixation, but there were more reoperations in the traction group (P = 0.04). Patients treated solely with a plaster cast had a mean of 4° increased extension of the affected elbow compared to 1° in the crossed pin fixation group (P = 0.02). Though this has little clinical relevance, it does indicate improved reduction in the operated patients, as one would expect.
Conclusions
The introduction of crossed wire fixation has significantly reduced the number of days for which patients are hospitalised for SCHF. The rate of nerve injuries in Gartland type 3 fractures is high. Despite the fact that this study includes the first patients to be treated with crossed wire fixation at our institution, no significant increase in the risk of complications could be found compared to skeletal traction.